title: Nutritional state alters the association between free triiodothyronine levels and mortality in hemodialysis patients.
abstract: BACKGROUND
  Serum free triiodothyronine (fT3) level is suggested to be a risk factor for mortality in unselected dialysis patients. We investigated the prognostic value of serum fT3 levels and also low-T3 syndrome on overall survival in a large cohort of hemodialysis (HD) patients with normal thyroid-stimulating hormone levels.
  
  
  METHODS
  A total of 669 prevalent HD patients were enrolled in the study. Serum fT3 level was measured by enzyme immune assay in frozen sera samples at the time of enrollment. Overall mortality was assessed during 48 months of follow-up.
  
  
  RESULTS
  Baseline fT3 was 1.47 ± 0.43 (0.01-2.98) pg/ml, and low-T3 syndrome was present in 71.7% of the cases. During a mean follow-up of 34 ± 16 months, 165 (24.7%) patients died. fT3 level was a strong predictor for mortality in crude and adjusted Cox models including albumin or high-sensitivity C-reactive protein (hs-CRP). Further adjustment for both albumin and hs-CRP made the impact of fT3 on mortality disappear. The presence of low-T3 syndrome was associated with mortality in only the unadjusted model.
  
  
  CONCLUSIONS
  Low-T3 syndrome is a frequent finding among HD patients, but it does not predict outcome. However, serum fT3 level is a strong and inverse mortality predictor, in part explained by its underlying association with nutritional state and inflammation.
authors.affiliation: Division of Nephrology, Ataturk Training and Research Hospital, Izmir, Turkey.
authors.forename: Kezban Pinar
authors.initials: KP
authors.lastname: Ozen
authors.forename: Gulay
authors.initials: G
authors.lastname: Asci
authors.forename: Ozkan
authors.initials: O
authors.lastname: Gungor
authors.forename: Juan Jesus
authors.initials: JJ
authors.lastname: Carrero
authors.forename: Fatih
authors.initials: F
authors.lastname: Kircelli
authors.forename: Erhan
authors.initials: E
authors.lastname: Tatar
authors.forename: Ebru
authors.initials: E
authors.lastname: Sevinc Ok
authors.forename: Mehmet
authors.initials: M
authors.lastname: Ozkahya
authors.forename: Huseyin
authors.initials: H
authors.lastname: Toz
authors.forename: Mustafa
authors.initials: M
authors.lastname: Cirit
authors.forename: Ali
authors.initials: A
authors.lastname: Basci
authors.forename: Ercan
authors.initials: E
authors.lastname: Ok
mesh_terms: D000368:Aged; D015331:Cohort Studies; D015897:Comorbidity; D005067:Euthyroid Sick Syndromes / Q000378:metabolism; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007124:Immunoenzyme Techniques; D007676:Kidney Failure, Chronic / Q000097:blood* / Q000401:mortality*; D008297:Male; D008875:Middle Aged; D009752:Nutritional Status; D016016:Proportional Hazards Models; D006435:Renal Dialysis / Q000379:methods*; D012307:Risk Factors; D013972:Thyrotropin / Q000378:metabolism; D014284:Triiodothyronine / Q000097:blood*
chemical_list: D014284:Triiodothyronine; D013972:Thyrotropin